Built for success

Siebern Visser, a member of the information technology department at Park Place of Elmhurst in suburban Chicago, tends to some of the behind-the-scenes equipment his department oversees. Technical dem
Siebern Visser, a member of the information technology department at Park Place of Elmhurst in suburban Chicago, tends to some of the behind-the-scenes equipment his department oversees. Technical dem

When one of Gary Timmers' customers in Los Angeles wanted to upgrade cable and Wi-Fi for its residents, there was simply no room to do it.

Officials at the 15-acre campus hadn't considered how their technology needs would bloom and had failed to dig outdoor trenches or install pipes in interior walls to carry information conduits down building hallways.

That also left them struggling to incorporate new options for resident safety and security, like the multifaceted systems Timmers sells for Salient Networks.

In skilled nursing and assisted living settings, technology infrastructure is about far more than entertaining or connecting people. A resident's physical health and sense of independence might just depend on high-tech systems that require savvy design in new buildings and intelligent workarounds in outdated ones.

A combination of wired equipment and remote devices alert nurses to patient needs, sound alarms for everything from falls to fires and track the movements of those likely to elope.

With more communities employing a full range of resident safety services, the technological demands and design requirements are growing. But the success of such safety and security systems depends as much on the physical features of the facilities where they'll be employed as they do on the staff that works there.

“One of the biggest challenges senior living communities have is they shortchange their cabling infrastructure,” says Timmers, director of sale for Salient Networks' senior living division. “They don't think about the need to grow or expand.”

Timmers advises his customers to install fiber in a 4-inch plastic pipe, running a second one alongside for future use that could accommodate an expansion of services or the addition of a new wire type.

It's not just about cables or electrical wires. A robust system might require hundreds of pieces of equipment, some of it hardwired, some wireless, and all of it essential to daily operations. Anything from concrete walls to a wonky refrigerator can interfere with communication devices.

That makes planning a new system as important as actually installing it. Experts suggest building a forward-thinking team with members who understand patient and staff needs as well as the building's layout and how it will function once populated.

“In an ideal world, the first thing I'd do, I'd meet with everyone from the architect, the door manufacturers, the install team as well as the management team,” says Steve Redeker, CEO of PalCare, a Palatium Care Company. 

Designing a system, he says, depends largely on resident acuity and an administration's aversion to risk. But cost is also an important factor to consider in securing any building.

For instance, a memory care center in Arizona might be compelled to bring nature in with multiple glass windows and doors. But those doors are an attractive escape route for sundowners, and might cost $5,000 to $10,000 each to secure with magnetic locks and band monitors.

Those who provide resident safety and security systems find that they're being brought in earlier in the process more often to streamline efforts and reduce expenses later.

Brad Hyder of TekTone Sound and Signal Manufacturing suggests hiring a systems integrator to redesign an existing system.

“These companies have experience in installing different safety systems across a broad spectrum, usually fire alarm, security and nurse call systems,” he says. “For new construction, an electrical or mechanical engineer should coordinate with the systems integrator to ensure they are familiar with installing all of the systems .”

RF Technologies sends a sales representative and an engineer on a site survey for every job, going beyond blueprints to understand possible challenges presented by exterior courtyards, concrete-encased structures and competing electronics.

Myron Kowal, founder and CEO of RCare, says retrofitting a building for a new system is still the most common encounter for safety system companies.

“We don't get a choice about what our conditions will be,” he says. “It's a wireless world, so it's really hard to even know how things will work until you're in … but design is as critical as anything can be as far as having good RF (radio frequency) coverage.”

Like many companies, RCare uses lower frequency signals to ensure reliability and avoid sharing valuable Wi-Fi bandwidth. The signal bounces from locator or transmitters strategically placed to work through fire walls, around corners, in elevators, and past other obstacles that might interrupt critical messages.

Spectrum analyzers can help a design team figure out how well signals will be propagated in specific areas, a step Kowal says is key to everything.

Getting builders and end-users talking early about issues raised during analysis can help head off potential problems.

Construction that uses reinforced concrete or masonry block has a “dampening effect” on signal strength, according to Mike Webster, senior solutions manager for STANLEY Healthcare. That will require more devices to transmit signals, increasing costs facility-wide.

Sometimes that's unavoidable.

“Most building codes are not sensitive to the wireless needs of the industry,” says Steve Varga, senior VP and chief technology officer for RF Technologies.

Designer choices

It's also more difficult to transmit a reliable wireless signal through metal, Hyder says.  Both metal walls and metal device housings should be axed if a wireless system is being considered.

Designing for aesthetics can also lead to issues: glass walls, for instance, are beautiful but offer few options for attaching communication devices or hiding infrastructure like wires.

But system engineers experienced in healthcare design know how to incorporate wiring and provide ideal space for the repeaters that bounce signals along hallways and other common areas.

Repeaters can be fairly high density in a setting with more than 100 beds or apartments. They can be hidden just above ceiling tiles, or at least placed out of residents' line of sight. Varga says they are as diminutive as possible, without flashing lights that might distract or worry some residents.

Special tracks called raceways also can hide cable and contribute to a home-like environment.

Selecting the wrong design options can make hiding wires — or even installing them — almost impossible. Redeker points to doors with channeled aluminum frames that extend 15 feet high.

For an elopement system to work well, though, all exit and entrance doors should operate by the same standards. And retrofitting, wiring and keypad and monitor installation add up.

“When it comes to door security, you cannot get chintzy,” says Redeker, whose server bounces routine signals to door alarms to ensure they're operational. “If they're your last line of defense, you have to know they're working.” 

Wi-Fi alternatives

In many settings, Wi-Fi is still integral to resident safety systems.

“For systems such as emergency call systems, resident technologies, wireless locking and personal tracking solutions, the wireless network contributes largely to their success,” says Virginia Depies, senior technology designer for Direct Supply Aptura. 

But not all Wi-Fi is created equal. Fifteen years ago, systems were being created to Wi-Fi standards, which still had limited office functions. Many facilities didn't purchase enough bandwidth — or can't afford to upgrade to the medical-grade RTOS recommended by STANLEY for its many access points and its ability to triangulate locations in real time. 

“It's important to understand the systems that will hang off the Wi-Fi solution, the priority level of users, as well as where the Wi-Fi may need to be more robust,” adds Depies.

In other cases, lower frequency transmissions can limit demands on valuable Wi-Fi bandwidth.

Other systems, including some designed by Salient, use virtual LAN, dividing and isolating a Wi-Fi signal for specific domains like EHR, security systems and resident Internet access.

“You don't want to be competing with people downloading videos or uploading information to medical records when there's a life-saving nurse call,” says Varga. RF Technologies' systems depend on a range of low-frequency signals — all below 1 gigahertz — to power nurse call and wander management systems.

But even refined signals face their share of challenges, including interference.

One of Kowal's clients complained of repeated interference with no obvious source. After several searches, his staff members discovered the facility had never deactivated an old card-reader system still stashed above a ceiling tile. It was operating at a frequency too close to the one chosen for the RCare solution.

It's also important to remember wireless infrastructure isn't efficient for all settings, says Depies. In some places, building codes require systems such as wander management and access control to be hardwired into the locking and egress methods.